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review of work capacity decisions

If you’re not happy with a work capacity decision, there are ways to have that decision reviewed.

Internal review by the insurer

If you dispute the work capacity decision made by the insurance agent, you must request an internal review of the decision.  This can be done by filling out and returning the internal review form that will be included in the notice of the decision.

Merit Review by the State Insurance Regulatory Authority

If you are still not happy with the decision by the insurance agent, you can request a Merit Review by the SIRA Merit Review Service.

This review can only take place when:

  • an internal review by the insurer has already been conducted, or
  • the insurer has failed to conduct an internal review and notify you of the decision within 30 days after they received the application for internal review.

The application for Merit Review must be made within 30 days after you receive notice of the insurer's decision.

Applications must be made using the Work capacity - application for merit review by the authority form and you must specify the reasons why you are seeking a review in that form.

You must also notify the insurer when an application for review is made.

Refer to the SIRA website or contact them on 13 10 50 for more information.

Procedural review by the Workers Compensation Independent Review Officer (WIRO)

After you have received a Merit Review, if you are still dissatisfied with the decision, you may also wish to lodge an application for a procedural review of the insurer's process in making the original decision.

You can do this with the Workers Compensation Independent Review Officer (WIRO). You can phone the WIRO on 13 94 76.